| Doctor Name: | HOLLY JEDLICKA |
| NPI Number: | 1033460480 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LISW-S |
| License Number: | 1000061 |
| Business Practice Address: | 9800 Jug St Nw Pataskala, OH - 430628691 |
| Business Phone Number: | 6143951395 |
| Business Fax Number: | 7409271516 |
| Mailing Address: | Po Box 92, KIRKERSVILLE |
| State: | OH |
| Postal Code: | 430330092 |
| Phone Number: | 6143951395 |
| Fax Number: | 7409271516 |
| NPI Enumeration Date: | 09/25/2012 |
| NPI Last Update Date: | 09/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 1000061 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |